Kidney stones are common, but can be treated – and prevented
On April 5th 2016, Fadi N. Joudi, MD, FACS published in The Wichita Eagle –
Kidney stones are common, with seven to 12 cases per 10,000 people in the United States each year. Ten percent of men and 5 percent of women will develop kidney stones in their lifetime. Once an individual has had a kidney stone, he or she is more likely to have another stone with the risk being up to 60 percent within 10 years.The majority of kidney stones are calcium‐based, with uric acid stones and stones related to recurrent urinary tract infections less common.Risk factors include dehydration, obesity, dietary lifestyle ﴾including high salt diet﴿, prior history of kidney stones, family history of kidney stones, bariatric surgery, history of inflammatory bowel disease ﴾Crohn’s and ulcerative colitis﴿ and recurrent infections with certain types of bacteria. Gout and having acidic urine are risk factors for uric acid stones. Some medications also can increase one’s risk of forming stones.
Patients with a kidney stone attack describe their pain as the worst they ever had. It is not uncommon to have a female patient describe the pain as worse than labor pain. The pain is typically on the side and radiates to the front or groin, gets worse then better, can be associated with nausea and vomiting, as well as blood in the urine. The symptoms can suggest the location where the stone is held up. Patients may not have any symptoms if the stone does not block the flow of urine.
Patients typically present to the emergency room or their family physician. If the symptoms are most consistent with kidney stone presentation, the best test is a CT scan without dye. This shows the size and location of the stone, which helps the physician decide the treatment plan.
Stones less than 5 mm in patients who do not have evidence of urinary tract infection, and whose pain can be managed with oral pain medications, usually are managed on an outpatient basis. Patients are asked to increase fluid intake and strain the urine so they can capture it and that can be sent for chemical analysis. A medication can be prescribed to help the stone pass.
Stones larger than 5 mm have a lower chance of passing spontaneously and a urologist will have to be involved in the patient’s care. Stones in the kidney or in the upper part of the ureter ﴾tube that connects the kidney to the bladder﴿ can be treated with a machine that emits sound waves called shockwave therapy, which is less invasive than other approaches. Stones in the mid and lower segment of the ureter are best treated with inserting a thin, tubular instrument that has a camera. The instrument can remove the stone with a basket or break it into smaller fragments with laser energy. If stones are large, the best approach is to insert a tube in the kidney through the back and break the stone with ultrasonic energy. This allows for removing a bigger stone burden in a shorter period of time.
Every patient who has had a kidney stone will tell you they want to know how to prevent further stones from forming. For those who have had stones once, we advise them to increase fluid intake ﴾more than two liters a day﴿ and follow dietary recommendations tailored to the stone composition. For those who have had stones more than once or who have less common types of stones, an evaluation is recommended.
An evaluation entails collection of urine over 24 hours to assess the different salts and minerals in the urine. Patients who have high calcium in the urine or those that have acidic urine may benefit from medications that address the medical condition ﴾decrease calcium in urine or make the urine less acidic﴿.
Patients with kidney stones should be reassured that urologists have effective treatments to take care of the stones and can help them formulate a plan to prevent them.